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How has public health changed over time?
Eras
Health Protection (antiquity-1830s): authority control of behaviors
Hygiene Movement (1840-1870s): sanitary conditions, environment
Contagion Control (180-1940s): Germ theory (Louis Pasteur)
Filling Holes in Medical System (control of diseases and care)
Health Promotion/Disease Prevention (1980s-2000): individual behavior
Population Health (NOW: public health)
Population Health Qs
1) Health Issues: physical and now mental health. (defining health)
2) Population: geographic area or group of people
3) Society wide concerns: what the society wants to change
4) Vulnerable populations: women and children
Approaches to population health: 1) Health Care: (access), Traditional
Public Health (community intervention) 3) social interventions (SDH)
High risk approach (resolving risk factors) and improving the average
approach:
Methods
Health Care, access, spread of disease, environmental, income,
etc.
Contributory causes: immediate cause of disease (medical pathology)
Determinants: identify causes of contributory cause
BIG GEMS: Behavior, Infection, Genetics, Geography, Environment,
Medical Care, SES
B: Behavior: actions that increase rate of exposure
I: Infection: long term disease
G: Genetics: can be the most important determinant of disease
G: Geography: infectious diseases in certain areas, frostbite,
heat, etc.
E: Environment: built and natural
Medical care: access
SES: education income, occupation
What changes in populations over time can affect health?
1) Demographic transition: decrease infant mortality increases life
expectancy,
2) Epidemiological transition (public health transition): as country
develops difference communicable (spreadable) diseases vs.
developed: are made.

3) Nutritional translation: poorly balanced diet to better foods

Chapter2: Evidence-Based Public Health

The P.E.R.I.E. approach (Chapter 2) KNOW THIS WELL

o I highly recommend you read and reread your textbook to prepare for this.
Understand what each letter stands for and the details associated with this
health problem-solving acronym. Know the types of studies/ study designs
used to determine associations and causality (etiology).
o How do we describe a health problem (Chapter 2)
o What is relative risk?
o What does dose-response mean?
Prevalence, incidence, morbidity, mortality, infant mortality rate
o (rates/proportions used to describe health)

P(burden, course, and distribution)

E (case, cohort, survey, Randomized controlled trials group association,
ancillary cuases: strength, biological plasubility, dose response,
consistency)
R (what worls) I When-Who-How E (REAim, reach, effectiveness,
maintainence, implemtation adoption)
Evidence Based Public Health Approach Questions
1) Problem: what is the problem
2) Etiology: what is the contributory cause
3) Recommendations: what works to reduce health impacts
4) Implementation: how can we get it done
5) Evaluation: how well do interventions work in practice (PERIE)
How can we describe a health problem? (Burden, Course, Distribution)
1) Burden of Disease (morbidity: disability, mortality: death)
2) Course of Disease: what happens
3) Distribution of Disease: who gets it and where are they
Incidence rates: (chance of getting disease)

Prevalence Rate (how many people have disease)

# living with a particular disease
# in the at-risk population
Case Fatality: Mortality/incidence rate (what happens once it occurs)

ETIOLOGY
Associations (group/ecological) in disease among ppl/places.
can help identify cause (risk indicators/markers)
real vs artifactual (identification, definition, interest)
difference in ability identifying disease (technology)
Type of Studies: (to identify etiology)
1) Population/Ecological (Group Association)
a. Can be confounders
b. Establish relationship
c. Can find occupational/environmental disease
2) Case Control (Individual Association)
a. Look at two groups (1) with disease (case) (2)
without disease (control) and compare w/ or w/o
expected exposure
b. Establish cause -> effect
3) Cohort (Cause precedes Effect)
a. People are grouped and followed over time to
determine effect
4) Altering Cause Alters Effect (Random Control Trial/
Natural Experiment)
5) Ancillary Support (Contributory Cause)
a. Strength of relationship: relative risk: probability
of developing with risk/ probability of developing
w/o risk
b. Dose-response relationship: more bad more harm.
c. Constituency of relationship: cause -> effect many
places
d. Biological plausibility: known mechanism
Establish A Cause?
1) Cause is associated with effect
2) Cause precedes effect in time
3) Alter cause, alter effect
Recommendations: What works to reduce health impact
Evidence based recommendations
Implementation
When-How-Who approach
When: Timing of intervention
Primary: before disease, focus on prevention
Secondary: after development of disease, before symptoms
Tertiary: after symptoms, before irreversible disability

Who: should the intervention be directed towards

How: type of intervention
- Education, Motivation, Obligation
Evaluation:
RE-AIM framework: reach, effectiveness, adoption, implementation,
maintenance
RE: evaluating the potential of intervention to get to people
AIM: acceptance of intervention in medicine/practice

Prevalence, incidence, morbidity, mortality, infant mortality rate

o (rates/proportions used to describe health)
Public Health Data: 6 Ss of public health data (Chapter 3)

Chapter 3: Tools of Population Health

What we do with Data (1) Informatics: (Gather: Collect (6s), Compile

(IMR,LE, HALE(PMSMSC) DALY), Present(Graphs)) The application of
informatics methods and theories to solve public health problems and
support public health goals
(2) Communication: (to communicate data, Present, Perceive (Dread,
Uncontrolability, Unfamiliary), Combine (Utility Scale), Decision Making
(Informed Consent, informe, of decision, shared decision) How we
receive, combine, and use information to make decisions.
Health Communications:

Health Informatics
Where do the data come from?
How are the data compiled?
How are the data presented?
Health Communication
What factors affect how we perceive the information?
What types of information need to be combined to make
health decisions?
How do we utilize information to make health decisions?
collect -> compile -> present -> perceive -> combine -> and decision
make health information
Collect: where does data come from
Compile: how is information put together to measure health
Present: how can we evaluate the quality of the information
Perceive: what factors affect how we perceive information
Combining: what types of information need to be combined to make
health decision
Decision making: how do we use information to make health decisions
COLLECT: SOURCES OF DATA
Type (Def, Uses, +/-)
(Single Cases, Statistics, Srubeys, Self reporting, sential monitoring,
syndromic surveyliliance)
1. Single Cases or small series
1. One or small number of cases
2. Alert of new disease and location
3. Useful for new diseases, needs doctors/people to rapidly
spread info
2. Statistics (vital statistics) and reportable diseases
1. vital statistics, birth, death, marriage, divorce, key
communicable diseases
2. required by law, change over law, identify cause
3. complete because of social/financial consequences; (-) rely
on institutional not individual reports (dely in data)
3. Surveys (e.g., BRFSS)

1. Draw conclusion about population

2. Allow inference about whole population; time and $ waste
4. Self-Reporting (e.g., adverse event)
1. Usually to an adverse event
2. Help identify unwanted consequences/ side effects
3. Useful when event follows medical usage, (-) relies on
individual reports not medical professional
5. Sentinel Monitoring (e.g., influenza monitoring to identify start of
outbreak)
1. Early warnings of unrecognized events
2. Real time monitoring (-) requires knowledge about disease
pattern
6. Syndrome surveillance (e.g., use of symptom patterns)
1. Use symptom patterns to raise alert about possible disease
2. Used to detect subtle changes (bioterrorism, outbreak)
3. Used for early warning w/o a diagnosable disease (-) does
not provide a diagnosis and can have false positives
COMPILE
- Population health status measures:
i. Infant mortality rate/life expectancy:
1. IMR: death in first year; life expectancy:
overall health
a. New measure: under-5 mortality
2. LE: health-adjusted life expectancy: adds LE to
quality of life. Measurements of (HALE:
LE*QOL)
a. Mobility: walk w/o help
b. Cognition
c. Self care: daily activities
d. Pain
e. Mood
f. Sensory organ function
3. Disability adjusted life year: DALY: (life years
lost because of things such as depression,
chronic diseases, cancers, DMV accidence,
obesity)
PRESENTATION
1. Graphics, internet, criteria for judging
2. Health literacy taken into account

PERCEIVE (how likely, how important, how soon)

1. Dread effect: hazards with very visual and real consequences
2. Unfamiliarity effect: not familiar with a potential harm or
cause
3. Uncontrollability effect: hazards not in our control are more
threatening (air planes vs cars)
**Selection of accurate and effective methods for conveying data is
key to health communications: (SUCCESS: principles of highly
successful communications)
1) Simplicity: short, memorable statement
2) Unexpectedness: get hold of ppls attention helps present facts
3) Concreteness specific examples that can be remembered
4) Credibility: source of information should be reliable
5) Emotions: connect with ppls emotions to get attention
6) Stories: we relate to stories more than anything
Decision analysis: vast information processing to combine info on
benefits and harms to reach quantitative decisions. Gives insight on
information that needs to be combined**
Combining Information
Utility scale: measure value (0- death, 1-no threat)
Expected utility: = probability * utility scale value: used in decision
trees
What other data should be included?

Discounting: emphasis on events in the immediate future (timing of

benefits and harms differ)
Decision maker: person/corporation that is a factor that should be
included somehow in data
How can we use health information to make healthcare decisions?
Approaches to using health information to make healthcare decisions)
Inform of decision: clinician takes charge and tells patient the
decision
Informed consent: patients ultimately need to give consent to
treatment
Shared decision: clinician gives options, patient adds to
decision
Chapter 4
Social and Behavioral Sciences and Public Health
Branches: Social Science psychology, sociology, anthropology, pol sci,
econ, communications, demography, geography
Levels of influence of social system on health
1. Individual lifestyle
2. Social and community networks
Interpersonal: family
Institutional: schools/employment
Community: social networds
3. SES, cultural, and environmental conditions
How do SES, culture, and religion affect Health?
1) SES: income, occupation, education, life expectancy strongly
correlated with SES, more $: better access to medical care
resources, better neighborhoods, better food,
a. Gini Index: used to measure economic inequity, higher
inequality high rates of mortality,
b. Socioeconomic gradient
i. Living conditions, educational opportunities for
women and men , occupation exposures, access to
goods and services, family size, highrisk behaviors,
environment. Etc.
Culture
Defines a set of beliefs and morals for a group of people
Traditional healers, customs (cliterodectomy), etc.
Culture related to behavior (food, cooking,desirable)
Related to response to symptoms (ability to idneitify and
respond)

Type of intervention: some are/are not acetapble

Response to diseases: follow up and adherence
Religion
Prohibition of alcohol, rdrugs, premarital sex, etc.

Tier 1: representschangesinsocioeconomicfactors(e.g.,povertyreduction,improvededucation),often
referredtoassocialdeterminantsofhealth,
Tier2:interventionsthatchangetheenvironmentalcontexttomakehealthyoptionsthedefaultchoice,
regardlessofeducation,income,serviceprovision,orothersocietalfactors.
Tier3:s1timeorinfrequentprotectiveinterventionsthatdonotrequireongoingclinicalcare;these
generallyhavelessimpactthaninterventionsrepresentedbythebottom2tiersbecausetheynecessitate
reachingpeopleasindividualsratherthancollectively.Historicexamplesincludeimmunization,which
prevents2.5milliondeathsperyearamongchildrenglobally.3
Tier4:hefourthlevelofthepyramidrepresentsongoingclinicalinterventions,ofwhichinterventionsto
preventcardiovasculardiseasehavethegreatestpotentialhealthimpact

Tier5:Thepyramidsfifthtierrepresentshealtheducation(educationprovidedduringclinicalencounters
aswellaseducationinothersettings),whichisperceivedbysomeastheessenceofpublichealthaction
butisgenerallytheleasteffectivetypeofintervention.

What are Social Determinants of Health

SDH: (10)
1) Social status: value placed on certain characteristics (US:
income, education, occupation)
2) Social support or Alienation: being a part of a group helps with
motivation to be healthy, having someone drive you to the docs,
recovery, racism etc.
3) Food: food desert: high prices of good food
4) Housing: homelessness: poor nutrition, drug use, violence. Lack
of clean water, sanitation, mold/dust, cockroaches, structural
conditions
5) Education: more education better health
6) Work: occupational hazards, stress, health insurance,
unemployed: depression
7) Stress: more stress -> affects immune system-> heart problems
and depression
8) Transportation: options for cycling/walking (harder in less safe
neighborhoods)
9) Place: access to services, air pollution, built environment
10)
Access to Health Services: limited by insurance
SDH -> Health
Health disparities: difference in health linked to SES
disadvantage
Linked to historical disadvantage (gender, disability, race,
etc.)
Interventions can happen at four levels.
Group level - Interventions work to change knowledge, attitudes,
and practices about a health issue among members of a target
group
Organizational level - Interventions use the shared connection
between individuals to build changes in health behaviors and
environment.
Community level - Interventions work to change environmental
or social structures. Any intervention that enhances the health of
people throughout a geographic community occurs at this
ecological level.
Policy level - Interventions change laws or policies that will
facilitate health

Can Health Behavior be Changed?

0 Complex & multidimensional
0
Holistic: Involve the whole person
0 Composed of interrelated dimensions
0 Dynamic, ever-changing
0 Knowledge
0 Incentives
0 Barriers
downstream factors: directly involve individual and can be
intervened
mainstream factor, : individual with larger population (peer pressure,
level of taxation)
upstream factors: social structures and policies
How can health behavior be explained and predicted
Key Theories and Models:
Categorized in 3 levels
1) Intrapersonal: characteristic of the individual
a. Health Belief Model: takes in individual perceptions and
thoughts prior to making health decision.
i. Constructs
1. Perceived susceptibility: opinion of getting
the condition
2. Perceived Severity: serious of a condition
3. Perceived Benefits
4. Perceived Barriers
5. Cues to action: events that encourage
readiness to act (someone else in family has
disease)

b. Trans-theoretical Model (Stage of Change Model)

people go through stages when changing behavior not
significant changes at once

Theory of Planned Behavior

Intention is the main predictor of behavior
2) Interpersonal: relationship between people
a. Include family, peers, friends, etc Share support,
feelings, etc.

b. Model: Social Cognitive Model: (Social Learning

Theory): behavior requires an understanding of
i. Individual characteristics (knowledge skill)
ii. Influence in physical/social environment: peer
influence, family support
iii. Reciprocal determinism: interplay between
environment, behavior, personal factors (change
in one changes the others)
3) Population and community: social norms, structures govt. etc.
a. Diffusion of Innovation: how well a new
idea/product/social practice is adopting in population
i. Stages
1. Knowledge: people must know it exists
2. Persuasion: ppl develop opinion (positive or
negative)
3. Decision: people decide to adopt or reject
innovation
4. Implementation: innovation is tried
5. Confirmation: support for decision
(continued or rejected)
ii. Depends on: relative advantage (is it better than
the replacement) compatibility (does it work with
my values) complexity (is it easy to understand
and use) trailability (can be tried before becoming
permanent) observability (are the results easily to
observe and measurable)
iii. Early adopters, majority adopters, and laggers
1. Early: want creative, laggers: want
acceptance
****How can theories by Applied
Hayden guidelines (choosing and theory)
2) Identify health issue
3) Gather information
4) Identify reasons or causes for problem
5) Identity level of interaction (intrapersonal, interpersonal,
community) under which the reasons/causes most fit
6) Identify theory
Planning Framework (2 approaches)
1) Social Marketing: use and extension of traditional product
marketing to enforce behavior change
a. 4 Ps
i. Product: identifying the behavior that is being
marketed

ii. Price: identifying the benefits, barriers, and financial

costs
iii. Place: identify target audience
iv. Promotion: create a campaign
b. Rely on branding: works and symbols that help target
identify with service
2) Precede-Proceed
a. Structure to design and evaluate health education and
health followed by implementation promotion programs (9
total steps)
PRECEDE
Phase 1 - Social Diagnosis
0 Quality of life the perception of individuals or
groups that their needs are being satisfied and that
they are not being denied opportunities to pursue
happiness and fulfillment (Green, & Kreuter, 2005,
page 34)
Phase 2 - Epidemiological Diagnosis
5 Ds
1. Death (mortality)
2. Disease (morbidity)
3. Disability
4. Discomfort
5. Dissatisfaction
Develop program objectives which are:
0 Specific
(objective must be specific in who it applies to and what it is
meant to accomplish)
0 Measurable
(goal must address something measurable)
0 Action Verb
(goal should contain an action verb)
0 Realistic
(goal should be attainable)
0 Timely
(goal should have a time frame)
Phase 3 - Behavioral & Environmental Diagnosis
Predisposing factors antecedents of behavior change that provide
rationale or motivation for the behavior

Reinforcing factors factors following a behavior that provide the

continuing reward or incentive for the persistence or repetition
of the behavior
Enabling factors antecedents to behavioral or environmental
change that allow a motivation or environmental policy to be
realized
What inherent motivational forces provide reasons for taking a given
action?
0 CHANGEABLE Factors
Awareness, knowledge, beliefs, values, attitudes, existing skills,
behavioral intention
What would reinforce or SUPPORT new/old behaviors?
Changeable Factors:
0 Support from Family or Friends
0 Employer actions and policies
0 Health provider costs
0 Community resources
What factors or resources facilitate or impede (based on their
degree of availability) behavior?
CHANGEABLE Factors
Skills, health care resources, effective use of information
Phase 4/5 Intervention Alignment and Administrative &
Policy Assessment
0 Intervention alignment and the administrative and policy
assessment
PROCEED
Phase 6 - Implementation
0 Selection and implementation of the health promotion
program.
Phase 7 - Process Evaluation
0 Measure extent to which a program is delivered according to how
it was conceptualized.
Phase 8 - Impact Evaluation
Assessing immediate/short-term impact
0 An assessment of the long term impact and
epidemiological data on 5 Ds (death, disease, disability,
discomfort, and dissatisfaction)

Chapter 10
Health Care Levels
Primiary: first contact of providers of care (6 Cs)
1. Contact
2. Comprehensive
3. Coordinated
4. Continuity
5. Caring
6. Community
Secondary: Specialty Care (EM, Anthestiology, OBGYN)
Tetirary: subspecialty: plastic surgery
What Institutions make up healthcare?
Inpatient Facilties (24+ hours inside) and Outpatient Facilities
Inpatient: hospitals, nurshing homes, hospices
Outpatient: clinics
Medical group practices
Outpatient clinics at hospitals /medical facilities.
Surgery centers

Imaging centers
Mental or behavioral health centers
Lab centers
Gastrointestinal centers
Durable medical equipment rental facilities
Physical therapy centers
Chemotherapy and radiation therapy centers

What types of inpatient facilies exist in the US

1.. hospitals designed for short term stay
2.. long term care facilities
before: hospitals designed for people who are sick and more of a
shelter. Accredited by the Joint commission
have organized physician staff and 24 hour nursing service
today: specialized hospitals
most are non profit (run by state or universities)
hospitals provide surgical and outpatient services (tests)
hospital is more than a building, includes rehab serbives
Skilled Nursing and Rehav vs nusing home
Skilled nursing/rehab: designed for short term
What ype of outpatient facilties exist in the US?
Doctors offices, work place providers, community health centers
COMMUNITY HEALTH CENTER
Designed based on community empowerment philosophy
Located in federally designated medically-underserved areas or
serve federally-designated medically-underserved populations
Quality of Health Care Services?
Asssessed using structure, process, and outcome measures
Structure: infrastructure
Process: preduecures
Outcome: result of care
Characterizes of healthcare quality

1) Access and Service: access to needed care and

customer service
2) Qualified provided: licensed and rained
3) Syating healhy: services that help people
maintain good health
4) Getting better: quality of service that help
people reover
5) Living with illness: quality of services for
people with chronic illnesses
How health care can be coordinated among multiple institution that
provide healthcare services?
need to coordinate between medicine and public health (required $)
Health Care delivery System: linkage of institutions and health care
professional that take on the responsibility of delivering coordinated
care; aims to connect inpatient and outpatient services and short term
and long term. (VA and K P)
Kariser Permanetente and Vertans Adminstration systems:

What are the major public health agencies and functions (US Dept of Health and
Human Services)
Types of hospitals (how are they categorized)
Expectations of primary care providers (coordinated, continuity, etc)
o Primary, secondary, tertiary care (treatment/providers)

Electronic Records:
Spread info and data
Results management
Order entry management
Decision support management
Electronic communication and connectivity
Patient support
Administration process
Reporting and population health (IOM)
Can: improve patient safety, support the delivery of effective
patient care, facilitate management of chronic conditions, improve
efficiency
How is technology being used to improve the quality of care?
(ex: MRIS, surgeries, etc.)
What mechanism are being used to monitor and ensure the quality of
health care?

(Accreditation), requirements for certification, maintenance of license,

pay-for-performance. Using evidenced based clinical recommendations
quality
hospital privileges (hospitals set standards for physicians to
practice n their facilities) and approval to perform proeducured
accreditation
malpractice liability
disclosure of medical errors
Medical Errors: definicies in diagnostics on the part of the clinician.
System errors:: definicies in the system.
Patients must have (facts about event, presence of error or systems
faure, expression of regret formal apology)
State

and County Run Hospitals

Public or government hospital
Provides medical care free of charge
Urban public hospitals associated with medical schools

Long Term
Nursing facilities
Nursing homes
Designed for long term care
Limited amount of healthcare services
States enforce rules and regulations
Most run as private non-profits
Assisted living
Long term care for those who have less severe
impairments
May provide or coordinate health care
Dementia care
Hospice
Goal = provide comfort, emotional support; relieve pain

Chapter 12:
Goals and Roles of Governmental Public Health Agencies?
Goals
1) prevent epidemics and spread of disease
2) protect against environmental hazards
3) prevent injuries
4) promote and encourage healthy behaviors
5) ensure quality and accessibility of health services
6) respond to disaster

IOM Core Public Health Functions for govt. (apa)

1) Assessment: (monitor/identify and investigate health problems)
1) monitor health status to identify and solve community health
problems 2) diagnose and investigate health problems and
health hazards in the community.
2) Policy Development: (educate, use CP, policies)
a. 1) inform, educate, and empower people about health
issues
b. mobilize community partnerships and action to indeitify
and solve health problems
c. develop policies and plans that support indivudla nad
community health efforts
3) Assurance: (Laws, access to care, professional workforce,
check effectiveness)
a. Enforce laws and regulations that protect health and
ensure safety
b. Link to/Provide Car
c. Competent workforce
d. Evaluate effectiveness of services
4) Research for new solutions (ALL)

Medical Malpractice: differs from state to state.

Preponderance of evidence needed: malpractice is more likely than

note
Negligence law:
Current (22nd)
Secretary of Health and Human Services
Sylvia Mathews Burwell

Levels
Federal
State
Local Health Departments
Local Board of Health
Occurrence of bad outcome not the same as negligence.
Patient must establish conditions
1) A duty was owed: healthcare professional undertook care of
patient.
2) A duty was breached: failure for provider to meet standard.
3) The breach caused an injury: promimal cause: injury or other
outcome would have occurred if the negligent act had not
occuration
4) Damaged occurred: direct damage (lost earning) indirect (stress)
Jury may not understand though.
Roles of Local/State Agencies
Not in constitution (state)
State -> Local Health Department
Home rule: local autonomy model (Department have autonomy)
Branch office model: department is a branch of overarching
state
Department: responsible for

Immunizations for public

Watching/controlling commincable/enviro disease
outbreaks
Inspecting, licensing, screening,
Preparing public for disaster
Health Care Safety Net: local departments serve as
healthcare provide for people with outher sources of health
care
State:
Vital statistics
Licensing professions
Drinking water regulation, Medicaid, regulation
Role of Federal Govt:
Department of Health and Human Services (HHS): operates
agencies
CDC: (epi) prevention, data, investation, disease contorl
ATSDR (Agency for Toxiv substances and disease registry) :
provide guidance on health harzrds of toxins
NIH: largest budged devoted to research trabug programs to
inform public
FDA: safety of foods, drugs, vaccines, etc.
Health Resources and Services Administration (HRSA): equitable
access to care
Service and Mental Health Services Admin (SAMHSA): quality,
prevetion, of mental health
Indian Health Service: federally reconnzed tribes
Agency for Healthcare Research and Quality: improve outcomes
and qualityof health are
Administration for Children and Families (ACF)
promotes the economic and social well-being of families, children,
individuals and communities through a range of educational and
supportive programs
Administration for Community Living (ACL)
increase access to community support and resources for the unique
needs of older Americans and people with disabilities across the
lifespan.
Agency for Healthcare Research and Quality (AHRQ)
supports research designed to improve the quality of healthcare,
reduce its costs, address patient safety and medical errors, and
broaden access to essential services.
Agency for Toxic Substances and Disease Registry (ATSDR)
prevents exposure to toxic substances and adverse health effects and
diminished quality of life associated with exposure to hazardous

substances from waste sites, unplanned releases, and other sources of

pollution present in the environment.
Centers for Disease Control and Prevention (CDC)
provides leadership and direction in the prevention of and control of
diseases and other preventable conditions, and responding to public
health emergencies.
Centers for Medicare & Medicaid Services (CMS)
combines the oversight of the Medicare program, the Federal portion of
the Medicaid program and State Children's Health Insurance Program,
the Health Insurance Marketplace, and related quality assurance
activities.
Food and Drug Administration (FDA)
Ensures that food is safe, pure, and wholesome; human and animal
drugs, biological products, and medical devices are safe and effective;
and electronic products that emit radiation are safe.
Health Resources and Services Administration (HRSA)
is the primary Federal agency for improving access to health care
services for people who are uninsured, isolated or medically
vulnerable.
Indian Health Service (IHS)
provides a comprehensive health services delivery system for
American Indians and Alaska Natives
National Institutes of Health (NIH)
supports biomedical and behavioral research domestically and abroad
SAMHSA
Substance Abuse and Mental Health Services Administration provides
national leadership to ensure that knowledge acquired is effectively
used for the prevention and treatment of addictive and mental
disorders. It strives to improve access and reduce barriers to high
quality, effective programs and services for individuals who suffer from
or are at risk for these disorders, as well as for their families and
communities.

Global Health Organizations and Agencies

WHO: UN Org: policy development, coordinaton of service,s data
collect,ion, limited ability to nefornce recommendations, limited funing
UNICEF/UNAIDS
International Financing Organization (World Bank) human capital
prokect and healthcare delivery, funding assistance.. standardized
approach (bad)
Governmental aid (USAID)
How can public health agencies work together?
Other governmental agencies?
EPA (enviromenta protection agency)
Occuptation Safety (OHSA)
Department of Homeland Secruities/Agricuture.Housing/Energy
NGO?
Red Cross: volunteers for blood
Orgs help with research and services and education, many
around specific diasease
American cancer/heart/lung association
MADD (mothers against durnk driving)
Global funds tc.
Bill Gates
Kellogg, etc. etc.
How can public health agencies partner with health care?
Community Orientated Primary Care (Model): focus on healthcare

Effort to expland services from indiv to community needs,

directly uses people in community in process
1. Community DefintiionL how is community
defined
2. Community Characterization what are the
characteristics
3. Prioirizaton: what are the most important
issues
4. Detialed assemsent of the selected health
problem: most effective intervetions
5. Intervention: strategies to implement
intervention
6. Evoluation: how is success determined
Community Based Participatory Research:
Community Orientation Public Health (coordinated mobilized of
public and private efforts)

State
Chapter 12